Shoulder instability surgery Perth

Everything you need to know about shoulder

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Shoulder instability Perth

I have an unstable shoulder. Do I need surgery?

An unstable shoulder commonly occurs as a result of trauma. A fall or push against an elevated arm can result in a dislocation or instability. In contact sports such as AFL or rugby you are particularly prone to this type of injury. In rare occasions, instability can also occur without trauma, i.e. in your sleep or when reaching for objects. Atraumatic dislocations are often associated with hypermobility or a connective tissue disorder. Surgery can be required for shoulder instability and the indications depend on age, activity level and severity of the injury. If the injury is associated with a fracture surgery is often required. The frequency and number of dislocations also play an important role. The more unstable the shoulder (the more often and easier it dislocates) the more likely surgery is required.

Do I need shoulder surgery?

Surgery is sometimes needed to stabilise your shoulder joint. Whether you need shoulder surgery or not will depend on the severity of the injury and your individual needs.

In most cases, an acute shoulder dislocation is treated non-surgically, through a process called closed reduction. This involves putting your humerus (upper arm bone) back into its proper position in your glenoid (socket). This is usually done in an Emergency Department, you will get medications to relax your muscles and a doctor will apply a sling after the shoulder joint is placed back into its normal position.

If your risk of redislocation is low, physical therapy can be successful in managing your symptoms. Your physiotherapist will make recommendations and may ask you to avoid certain activities.

Athletes, however, commonly require surgery to stabilise their shoulder joint with ongoing instability, and the younger you are, the more likely you are to need shoulder surgery. Recurrent instability reaches almost 100% in teenagers. Contact sports will almost always lead to further dislocations if you decide not to have shoulder surgery.

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Shoulder instability surgeon Perth

Shoulder instability surgery explained

In short, if the shoulder joint has associated injuries such as a glenoid fracture or a rotator cuff tear or if there is a high risk of recurrent dislocations, surgery may be likely.

There are several types of surgical procedures that can be used to repair a shoulder dislocation, including open reduction, arthroscopic labral repair, and bone graft procedures. The type of surgery chosen will depend on the specifics of the injury.

Dr Sven Goebel, Shoulder Instability Surgeon Perth

Arthroscopic labral repair / stabilisation

If your shoulder is very unstable or you are a young athlete, the most common procedure you require is an arthroscopic stabilsation with repair of the labrum, This is done with small incisions and suture anchors. A rest period followed by a rehabilitation program will be required for success of the procedure.

Bone graft for recurrent shoulder dislocations (Latarjet procedure or iliac crest bone graft)

If you develop bone loss in the socket of your shoulder or you have had a large number of dislocations, you may need shoulder bone graft surgery to restore stability and function. Each time a shoulder dislocation occurs, more damage occurs, and over time, this can lead to bone loss of the glenoid (socket) making the instability even more likely.

Shoulder surgery risks

Risks of shoulder surgery

As with any type of surgery, there are some risks associated with shoulder instability surgery. I will explain these in detail during consultation.

General surgery risks

Very low, depending on comorbidities
Most commonly risk of infection (<1%)
Heart attack
Stroke
DVT

Shoulder instability surgery risks

Recurrent dislocation is approximately 8-10% after soft tissue procedure, about 1-2% in Latarjet procedure (bone graft)
Infection (<1%)
Non-union of bone graft (1-5%)
Implant failure
Risk of nerve injury (0.5-3%)
Pain post surgery
Frozen shoulder syndrome

Recovery time

What happens after surgery?

During consultation, I will talk about post-operative exercises for optimal recovery after shoulder instability surgery.

Download exercise booklet

You can find a PDF here: https://www.perthshoulderclinic.com/s/PSC-Physiotherapy-Program-Booklet

In general I recommend these timelines after surgery to return to specific activities:

Having a shower:

1 day after surgery

Light exercise:

8 weeks after surgery

Driving:

7-8 weeks post surgery

Normal exercise:

3-6 months after surgery

Going back to work:

14 days after surgery for office worker, up to 9 months for manual worker